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Mutual of Omaha presents Medicare Basics Health products underwritten by Mutual of Omaha Insurance Company For Producer Use Only. Not for use with the general public. Why Mutual of Omaha? A financially strong company with: - brand name recognition

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slide1

Mutual of Omaha

presents

Medicare Basics

Health products underwritten by Mutual of Omaha Insurance Company

For Producer Use Only. Not for use with the general public.

why mutual of omaha
Why Mutual of Omaha?
  • A financially strong company with:

-brand name recognition

-quality products, excellent service and

-committed to our community as demonstrated with our Wild Kingdom and sponsorship programs

why mutual of omaha3

WhyMutual of Omaha?

  • A financially strong company since 1909
  • Rated A+ (Superior) by A.M. Best
  • Second of 16, for financial strength and ability to meet contractual obligations
why mutual of omaha4

Why Mutual of Omaha?

  • A provider of Medicare supplement insurance since 1966
  • Mutual and United World paid $5.4 billion in Medicare supplement benefits*
  • Mutual and United World paid $780 million in Medicare supplement benefits in 2008 alone*
  • *Mutual of Omaha Actuarial Research, 2007
why mutual of omaha5
Why Mutual of Omaha?
  • Our Medicare supplement rates are top in the industry
  • We have timely underwriting
  • We have a competitive compensation package
  • Offer world class travel with incentive trips
  • Purchase quality leads with our affordable lead program
top in the industry
Top in the Industry
  • Ranked top three provider
  • Ranked 1st in agent sold Medicare supplement policies
  • Our earned premium has increased 42.2% in the last four years
medicare coverage

MedicareCoverage

Medicare Coverage

medicare coverage8
Medicare Coverage

Medicare serves 44.1 million Americans

  • 36.9 million seniors
  • 7.2 million disabled persons
  • Average benefit per enrollee-$10,460

Source: “Medicare Fast Facts” National Committee to Preserve Social Security and Medicare

medicare what is it
Medicare - What is it?

Medicare is a government regulated health

insurance program that provides coverage to:

  • People age 65 and older
  • People who are disabled
  • People who are in permanent kidney failure
  • People who have ALS (Lou Gehrig’s disease)
medicare eligibility part a
Medicare Eligibility-Part A

A person is eligible for Part A at age 65*

whether working or retired, if that

person has been covered by Social

Security long enough to qualify for

benefits.

* Some states allow coverage for individuals under age 65.

medicare eligibility part a11
Medicare Eligibility-Part A
  • A person who is under age 65 can get Part A benefits without paying premiums if he or she has received Social Security or Railroad Board disability benefits for 24 months.
  • People with ALS get Part A the month their disability benefits begin.
  • Persons, aged 65, who are not eligible under these conditions may enroll in Part A by paying the full cost.
medicare enrollment part a
Medicare Enrollment-Part A

Part A is premium-free for those who are

eligible for Social Security or Railroad

Retirement benefits.

medicare enrollment part b
Medicare Enrollment-Part B
  • Everyone who is entitled to Part A is automatically enrolled in Part B, but may reject it.
  • There is a premium charge for Part B.
  • Participants are encouraged to purchase Part B because the federal government pays three-fourths of the premium cost.
initial enrollment period
Initial Enrollment Period

An individual may join Medicare:

  • No sooner than three months prior to the month of his or her 65th birthday.
  • During the month of his or her 65th birthday.
  • No later than three months after the month of his or her birthday.
  • Mutual extends the Medicare supplement enrollment period-adding three months to each period.
medicare coverage15
Medicare Coverage

Medicare is divided into two parts:

  • Part A—in-patient hospital insurance
  • Part B—supplemental medical insurance
medicare part a
Medicare – Part A

Part A provides in-patient hospital care

  • Pays for a portion of services in
    • hospitals,
    • skilled nursing facilities,
    • home health care and
    • hospice care
  • Doesn’t cover physician or medical services
covered hospital services
Covered Hospital Services

Part A covered hospital services :

  • Room and board (semiprivate)
  • Operating and recovery room costs
  • Laboratory tests and x-rays
  • Drugs and medical supplies such as dressings
  • General nursing and rehabilitation services
  • Durable Medical Equipment
  • Blood Transfusions (after first three pints)
benefit periods
Benefit Periods

A benefit period:

  • begins the first day a person receives Medicare covered services in a hospital and
  • ends when the patient has been out of the hospital or skilled nursing facility for 60 days in a row.
new benefit period
New Benefit Period
  • If a person enters a hospital again after 60

days, a new benefit period begins.

  • All Part A benefits (except for the lifetime reserve days) are renewed.
  • There is no limit to the number of benefit periods a person can have for hospital or skilled nursing facility care.
reserve days
Reserve Days
  • Hospital inpatient reserve days are a lifetime reserve of 60 days.
  • A reserve day can be used only one time.
  • Reserve days are not renewable for a second benefit period the way the first 90 days are.
inpatient hospital benefits
Inpatient Hospital Benefits
  • Inpatient Hospital Coverage - Part A
  • Participant pays $1,068.00 for first 60 days
  • The participant’s coinsurance is:
  • - $267 for days 61-90
  • - $534 for days 91-150 (Lifetime Reserve)
  • -Full cost for days 151st and after (Medicare pays $0 cost)
skilled nursing facility care
Skilled Nursing Facility Care
  • Medicare helps pay up to 100 days of care during a benefit period.
  • Medicare will pay benefits only if the skilled nursing facility(primarily provides skilled nursing and rehabilitation services)is certified by Medicare.
skilled nursing facility care23
Skilled Nursing Facility Care

Skilled Nursing Care Services:

  • Semiprivate room and all meals
  • Regular nursing and rehabilitation services
  • Medications and medical supplies and appliances
skilled nursing facility benefits
Skilled Nursing Facility Benefits

Skilled Nursing Care Benefits

  • Participant’s Coinsurance is:

- $0 for the first 20 days (Medicare pays 100%)

- $133.50 a day for days 21-100

- 100% (Medicare pays 0% after day 100)

home health care services
Home HealthCare Services

Covered home health care services

when confinement is at home include:

  • Part-time nursing care
  • Physical, speech and occupational therapy
  • Medical social and home health aide services
  • Use of medical supplies and durable medical equipment

There is no longer a requirement for hospitalization nor any maximum on

the number of visits.

home health care benefits
Home Health Care Benefits

To receive Medicare home health care

benefits, an individual must meet four

conditions:

  • A physician certifies the individual needs care at home and develops a plan of care.
  • The individual needs skilled nursing care or therapeutic nursing services.
  • The individual must be confined to home.
  • The agency must be Medicare approved.
home health care benefits27
Home Health Care Benefits

Home Health Care benefits:

  • Participant pays nothing except for durable medical equipment which is subject to a 20% coinsurance under Part B.

Services must be provided by a Medicare certified home

health agency. A home health agency is defined as a public or

private agency that specializes in skilled nursing services and

other therapeutic nursing services.

hospice benefits part a
Hospice Benefits-Part A

Under certain conditions, Part A can pay

for hospice care for terminally ill

persons. Covered services include:

  • Physician services/Nursing care
  • Medical appliances and supplies
  • Outpatient drugs for pain relief
  • Short-term in-patient care
  • Counseling/therapies
  • Home health aide and homemaker services
hospice benefits
Hospice Benefits

Hospice benefits are paid as follows:

  • Medicare pays 100% for covered services.
  • Participant pays: limited cost for outpatient drugs and inpatient respite care.
blood
Blood
  • Blood is covered under Medicare Part A and Part B.
  • When blood is required, participant pays for first three pints.
medicare part b
Medicare – Part B

Part Bcan help pay for:

  • Physician and surgeon services
  • Home health visits for patients requiring skilled care
  • Physical therapy and speech pathology services on an outpatient basis and on a limited basis in the patient’s home.
  • Miscellaneous medical services and supplies
medicare part b benefits
Medicare Part B Benefits
  • The Participant pays:
  • The Part B calendar year deductible -$135
  • 20% of the Coinsurance
medicare approved charges
Medicare Approved Charges
  • Medicare bases it payments on “reasonable charges.”
  • Medicare can pay only 80% of the approved charge, even if it is less than the actual charge.
  • For entities not taking “assignment” the Medicare beneficiary would pay any excess charges.
exclusions
Exclusions

Medicare provides basic protection, it does

not cover all of a person’s health care

expenses. It does not pay for:

  • Services not reasonable, necessary or outside the U. S.
  • Personal comfort items and most immunizations
  • Cosmetic surgery, drugs or medicines taken at home (except for hospice)
  • Eye exams/Dental /Foot care/Hearing aids/Acupuncture
  • Private nurses
  • Custodial care/intermediate care/skilled care beyond 100 days a year.
medicare supplements

Medicare Supplements

Medicare Supplement Insurance Plans

medicare supplement insurance
Medicare Supplement Insurance

Basic Things You Should Know:

  • Duplicate coverage is not allowed.
  • You are required to provide an outline of coverage and “Guide to Health Insurance for People with Medicare” to each Medicare client at the time of sale.
  • Policy must be delivered within 30 days from date of issue.
medicare supplement insurance37
Medicare Supplement Insurance
  • Private insurance subject to federal and state laws designed to help pay where Medicare does not pay
  • Standardized Plans A - J
  • Plan A is basic; Plan J has the most coverage
  • Plans B - J contain at least Plan A benefits
  • Two new plans- K and L
medicare supplement basic benefits
Medicare Supplement-Basic Benefits

Plans A-J must have five basic benefits:

  • Part A hospital co-insurance for 61-90 days in a benefit period.
  • Part A hospital co-insurance for lifetime reserve days 91-150.
  • Must pay eligible expenses for an additional 365 hospital days after Medicare benefits end.
  • Must pay 20% of Medicare approved expenses after the calendar year deductible is met.
  • Must all pay for the first three pints of blood (annually).
medicare plans k and l
Medicare Plans K and L

Plans K and L:

  • Offer most of the same benefits as A-G
  • Have lower monthly premiums
  • Cost-sharing has set limits
  • Have higher co-payments
  • Provide no coverage for the Part B deductible
  • Have caps on out-of-pocket costs
medicare plan k
Medicare Plan K
  • Covers 100% of the Part A hospital coinsurance, additional 365 days and Part B cost sharing for preventive services
  • Covers 50% of the Part A deductible, Skilled Nursing coinsurance for days 21-100, Part A coinsurance for hospice care, Part B co-insurance and the first three pints of blood until the annual out-of-pocket is met
  • Out-of-pocket limit increases each year for inflation
medicare plan l
Medicare Plan L
  • Covers 100% of the Part A hospital coinsurance, additional 365 days and Part B cost sharing for preventive services.
  • Covers 75% of the Part A deductible, Skilled Nursing coinsurance for days 21-100, Part A coinsurance for hospice care, Part B co-insurance and the first three pints of blood until the annual out-of-pocket is met.
  • Out-of-pocket limit increases each year for inflation.
medicare supplement plans
Medicare Supplement Plans

Medicare Supplement Plans

medicare supplement plans44
Medicare Supplement Plans

Medicare Plans A – G

  • Part A deductible
  • Part A coinsurance
  • Lifetime reserve days
  • Additional 365 days
  • Skilled nursing facility care
  • Blood (first three pints)
medicare supplement plans45
Medicare Supplement Plans

Medicare Plans A – G

  • Part B deductible
  • Part B coinsurance
  • Emergency care outside the U.S.
  • Part B excess charges
  • At-home recovery
  • Basic drugs
mutual care select
Mutual Care SELECT
  • Mutual Care SELECT contains a group of participating network hospitals.
  • Part A deductible is waived when services are received from participating network hospitals.
  • If services are received out of network, Part A deductible is not waived.
  • We will cover the cost of Part A deductible when Insured receives emergency services from a nonparticipating hospital.
mutual care select47
Mutual Care SELECT

Plans B – G

  • Part A deductible
  • Part A coinsurance
  • Lifetime reserve days
  • Additional 365 lifetime reserve days
mutual care select48
Mutual Care SELECT

Plans B – G

  • Skilled nursing facility care
  • Part B deductible
  • Part B coinsurance
  • Blood(first three pints)
mutual care select49
Mutual Care SELECT

Plans B – G

  • At-home recovery
  • Part B excess charges
  • Emergency care outside the U.S.
  • Preventive care
underwriting

Underwriting

Underwriting

underwriting51
Underwriting

Health

  • Policies are selectively issued
  • No eliminations, benefit limitations or premium rate-ups will be used
  • Applicant will be accepted or declined
  • If any health question is answered “Yes” the applicant is not eligible for coverage.
underwriting52
Underwriting

Guarantee Issue for Eligible Persons

  • Guarantee issuance if individual applies within 63 days of losing coverage and
  • He or she submits evidence of the date of the termination with the application.
  • Preexisting condition limitation will be waived for guaranteed issue.
completing the application
Completing the Application

Basic points to follow when completing

the application.

  • Application may be sent through the mail
  • Black ink is preferred
  • No blank spaces, “not applicable”, “N/A” or a wavy line can be accepted as an answer to a question.
  • Any section which is “X’d” out, lined out, whited out or blocked out is not acceptable.
  • Always recheck the application and the entire application must be received intact by Mutual.
underwriting54
Underwriting
  • Our underwriting team wants to get your business issued quickly.
  • Call them to discuss the details of a case and expedite the underwriting process.

1-800-995-9324 - Medicare Supplement

medicare modernization act

Medicare Modernization Act

Medicare Modernization Act

medicare modernization act56
Medicare Modernization Act
  • Assists with prescription drug costs

-Medicare prescription drug plans—Part D

  • New health care choices

-Medicare Advantage plans

-Regional Preferred Provider Organization plans

what is medicare part d
What is Medicare Part D?
  • Outpatient prescription drug benefit
  • Operated by private companies that are subsidized by the government
  • Plans may vary substantially, covering different drugs, charging their own premiums and co-pays
  • Must be comparable to the “Standard Coverage”
what is medicare part d59
What is Medicare Part D?

Prescription Drug Plans will decide

which drugs they will cover

  • “Formulary” or preferred drug list
  • In most cases, at least two drugs will be covered in each “therapy class”
    • Drugs for heart conditions, high cholesterol, diabetes, etc.
medicare part d eligibility
MedicarePart D - Eligibility

Who is eligible for Part D?

Your client must be entitled to the benefits under Medicare Part A and/or enrolled in Part B, and live in the plan’s service area, to take advantage of the Part D program.

medicare part d eligibility62
Medicare Part D - Eligibility

When can a person turning 65 apply for

Part D?

People turning age 65 after the initial Medicare Part D open enrollment period may enroll in Part D, 3 months before or after the month in which they turn age 65. (a seven-month period)

Example: If your 65th birthday is June 21st you can enrollas early as March 1st - or as late as September 30th.

part d timelines
Part D Timelines

Annual enrollment period

November 15-December 31

part d
Part D

Program Effective Dates

Part D policies are effective the first day of the month following enrollment form submission. Accurately completed enrollment forms that are received seven or more days prior to the end of the month generally will result in a plan effective date the first day of the next month.

Example: Enrollment form received on March 22 and it does not need follow-up, coverage will be effective on April 1. Incomplete or inaccurate enrollment forms could delay the effective date!!

how to help clients select a plan
How to help Clients select a Plan
  • What is Part D?
  • What Part D plans are available in my region?
  • How much am I paying today for prescriptions?
  • Will my current prescriptions be covered under Part D?
  • What pharmacies are in the plan’s network?
how to help clients select a plan68
How to help Clients select a Plan
  • Will there be a monthly premium and/or deductible with the plan I choose?
  • Are there any gaps in coverage?
  • What enhanced or additional benefits may be available with the plan?
  • How much money can I save by joining a plan?
  • Who is the plan sponsor, is it reliable?
part d69
Part D

Annual Certification Required

The government requires that people selling Part D plans be certified through each company they sell it through. Every company will provide various methods to become certified. (classroom training, website, etc.)

penalties
Penalties

CMS may:

  • Suspend new enrollments
  • Withhold payment for new enrollees

You are personally liable!

medicare modernization act71

Medicare Modernization Act

Medicare Advantage Plans

medicare advantage plans
Medicare Advantage Plans
  • Formerly Medicare Part C
  • Government-subsidized private health plans
  • Direct alternative to Medicare (Parts A & B)
  • Combine “core” Medicare benefits with certain supplemental benefits.
medicare advantage enrollment
Medicare Advantage Enrollment
  • Must have Medicare Part A and Part B coverage.
  • Must live in the service area of the plan.
  • Must not have end stage renal disease.
  • May enroll at any time, if accepting enrollees.
participation in plans
Participation in Plans

Medicare+Choice/Medicare Advantage Plans, 1990-2005

medicare advantage plans76
Medicare Advantage Plans

Medicare Advantage plans:

  • Managed Care programs, HMOs , PPOs, POS plans
  • Private Fee-for-Service plans, (PFFS)

3. Special Needs Plans

medicare advantage plans77
Medicare Advantage Plans

Depending on the type of plan, enrollees may pay:

  • Deductibles
  • Co-payments
  • Cost-sharing for additional benefits
  • Additional premiums for some benefits and/or services
medicare advantage plans78
Medicare Advantage Plans
  • Hard to budget monthly health care expenses
  • Plan may be cancelled and can terminate its members
  • Can choose from a network of providers, which can fluctuate
  • Pre-certification may be required for some types of care
  • Can only use doctors and hospitals in the network
medicare advantage plans79
Medicare Advantage Plans
  • All Medicare Advantage Plans must provide some prescription drug coverage.
  • If a Medicare Advantage participant enrolls in a Part D plan, the Medicare Advantage plan will be cancelled.
medicare advantage plans80
Medicare Advantage Plans

Encourage your clients to look

closely before they decide what’s

best for them.

medicare 2008
Medicare 2008

Questions?

Health products underwritten by Mutual of Omaha Insurance Company

For Producer Use Only. Not for use with the general public.

mutual s medicare supplement
Mutual’s Medicare Supplement

Mutual’s

Medicare Supplement Plans

mutual care select85
Mutual Care SELECT
  • Mutual Care SELECT contains a group of participating network hospitals.
  • Part A deductible is waived when services are received from participating network hospitals.
  • If services are received out of network, Part A deductible is not waived.
  • We will cover the cost of Part A deductible when Insured receives emergency services from a nonparticipating hospital.
unauthorized entities florida
Unauthorized Entities-Florida
  • The state of Florida has taken a very strong position on the issue of unauthorized entities.
  • An unauthorized entity is an insurance company that is not licensed by the Florida Department of Insurance.
  • Agents and brokers have the responsibility for conducting reasonable research to ensure that they are not writing policies or placing business with unauthorized entities.
unauthorized entities florida92
Unauthorized Entities-Florida
  • Lack of careful screening can result in significant financial loss to Florida residents due to unpaid claims and /or theft of premiums.
  • Producers may be liable when representing unauthorized entities.
  • It is the responsibility of producers to give fair and accurate information regarding the companies they represent.
  • Questions can be directed to the Florida Department of Insurance at 1-800-342-2762.